Vascular disease

Question 1

signs of PAD

Answer 1

cold extremities, loss of hair, claudication

Question 2

first line testing for suspected PAD?

Answer 2

ankle brachial index

Question 3

Most commonly occluded vessel

Answer 3

superficial femoral

Question 4

most effective treatment for superficial femoral athersclerosis?

Answer 4

fem-pop bypass with saphenous vein graft

Question 5

how to treat tibial and pedal disease?

Answer 5

conservative treatment and wound care is often adequate
intervention is indicated when
failure to heal within 2-3 weeks
resting pain wakes patient at night

Question 6

amputation effects?

Answer 6

1st toe amputation increases effort by 5-10%
next level that can be fitted for prosthesis is below knee - 50% increase effort for walking
100% increase for walking after above knee amputation

Question 7

S/S acute arterial thrombosis

Answer 7

sudden onset of pain

loss or reduction of pulses, sensation loss

Question 8

how to treat acute arterial thrombosis

Answer 8

heparin
immediate revascularization (catheter TPA)
after 6 hours tissue loss approaches 100%

Question 9

Virchow’s Triad

Answer 9

hypercoagulability
endothelial injury/inflammation
stasis

Question 10

MC complaint of a PE

Answer 10

SOB

right sided chest pain

Question 11

MC complaint for DVT

Answer 11

calf pain “charley horse”

Question 12

unilateral leg swelling think….

bilateral think…

Answer 12

DVT

CHF, kidney

Question 13

US testing for dvt

Answer 13

Veins are normally compressible, if it does not it is filled with clot

Question 14

best test for PE?

Answer 14

spiral CT with contrast
Contrast is necessary to rule in/out a PE
If they can’t get the IV contrast then consider treating prophylactically

Question 15

another option for pts that can’t use contrast?

Answer 15

VQ scan, pt must have a normal CXR first
The tracer is inhaled to show the entire lung(s)
Then it is injected to show where the blood goes

Question 16

medical tx for VTE?

Answer 16

-generally treat for 3 months
-use anticoagulants
-Heparin must be used IV continuously, good to start with in hospital bc it is short acting and can be stopped if pt bleeds….must have pTT checked every 6 hours or so
Coumadin is oral-need to monitor INR, pt must be on this for 3 days before changes to INR are seen…..therefore heparin or lovenox is the bridge towards using coumadin….reversible w/Vit K
Lovenox/LWMH-can be sent home w/pt even though it is injectable, longer acting
NOACs-no monitoring required however no reversal

Question 17

massive PE treatment

Answer 17

Fibrinolysis can be used up to 14 days

recombinant tissue plasminogen activator (tPA)

Question 18

S/S venous insufficency

Answer 18

primary finding is pitting edema
secondary changes occur over time
taut skin
shiny
brown pigmentation
skin thickening and fibrous
ulcers commonly develop (medial and anterior)

Question 19

venous insufficency treatment?

Answer 19

Compression stockings are key
Elevation of legs above level of heart while sleeping
Pneumatic compression device
Avoidance of standing and sitting for prolonged periods

Question 20

septic thromboplebitis tx

Answer 20

Empiric vancomycin (staphylococci coverage) and ceftriaxone (Enterobacteriaceae coverage)